Colonial Life disability coverage replaces income when a covered condition keeps the patient from working, and this 9-page claim starts the benefit. Colonial Life says to file once a doctor has advised the patient to stop working for medical reasons; pregnancy, cancer, heart attack, stroke and surgery are common examples. The physician statement documents the diagnosis, treatment, restrictions, and the dates the patient can't work and is expected back.
The policy owner completes Section 1, the claimant statement, and the employer completes Section 2, which is not needed if the patient was not employed when the disability began. The treating physician completes and signs Section 3, the physician statement that starts on page 7.
Page 1 takes the claimant's and policy owner's details, whether the claim is for an accident or sickness, the date an accident occurred (not when treated), the condition that keeps the patient from working, prior treatment for the same condition, and how an accident happened, with a police report for an auto accident if available. An optional release lets Colonial Life discuss the claim with an agent, employer or family member.
The policy owner reports whether the condition is work related and any workers' compensation claim (with the Report of Injury), dates unable to work, job title, duties that can't be performed and the job's physical demands. If not employed, they list activities of daily living they can't perform and dates of house confinement. They add return-to-work dates, any hospital stay and every treating physician, then sign the certification acknowledging the fraud statements.
The employer gives the employee's title, hire date, scheduled hours, date last worked, any termination date, the dates the employee can't work full time, when sick leave was exhausted, any FMLA approval dates, workers' compensation details and pay. It also states whether light or partial duty is allowed, expected and actual return-to-work dates, and the physical duties of the job, then an authorized person signs.
State whether the condition is due to an accidental injury or the patient's employment, the primary diagnosis that prevents work (for pregnancy, list complications), the date first treated, and any secondary diagnoses. Give when symptoms first appeared, the new patient consultation date, symptoms and current treatment plan, all treatment dates for the 18 months before the disability, tests and surgeries with dates and CPT codes, and the last and next visit dates.
Estimate when significant improvement is expected (1 to 2, 3 to 4, 5 to 6, or more than 6 months) and say whether any restrictions or limitations are permanent. Limitations are what the patient cannot do; restrictions are what the patient should not do. Then give the dates unable to work full time, the expected return-to-work date, any part-time dates and hours, and the actual return-to-work date.
Record any house confinement dates, the activities of daily living the patient cannot perform and for what dates, hospitalizations and office visits in the last 6 months, how often you see the patient, and any specialist referral. For pregnancy, give the estimated delivery date, date first treated, delivery date and type, procedure code, anesthesia during delivery, and the newborn's confinement dates and diagnosis.
The physician signs and dates the statement and gives the physician or group name, patient account number, specialty, contact numbers, address and tax ID or SSN. The block also asks whether the office accepts medical record requests by fax, needs a special authorization, uses a patient portal, accepts the standard HIPAA release and has an authorization on file, and who referred the patient, if anyone.
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Disability Claim
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Section 3, the physician statement, which starts on page 7 of the 9-page form. It covers the primary and secondary diagnoses, symptoms and treatment plan, tests and surgeries, restrictions and limitations, dates unable to work, expected and actual return to work, and pregnancy details where relevant. The physician signs and adds practice and tax ID details.
The form defines it as the patient being kept at home, in the house or yard, by the condition, while still allowed to follow the physician's orders even if that means leaving home. Section 3 asks whether the condition required house confinement and for which dates, along with any activities of daily living the patient cannot perform.
Yes. After the initial claim on form 64387, continuing claims go on the Continuing Disability Claim, form 46988, which Colonial Life posts on the same disability claim page. Both can be faxed or mailed on paper, or the patient can file and upload documents online through coloniallife.com.
Yes. The patient logs in at coloniallife.com, chooses File an Online Claim and can set up direct deposit there; Colonial Life says this is the fastest way to start receiving benefits. The physician's completed Section 3 and supporting records can be uploaded to the claim, including after it was first opened.